Still Coughing After COVID, Throat Itchy With a Lump of Phlegm Stuck? Doctor Luo Dalun: Tell Cold From Heat and the Lingering Cough Is Easy to Fix

Patient search terms: cough after COVID / lingering cough / long covid cough / itchy throat with phlegm / white phlegm / chronic cough won’t go away / cough after flu

Corresponding conditions: residual cough after external contraction · phlegm retention · lung dryness with yin deficiency · cold pathogen lingering · post-viral recovery

Opening: twenty-plus days on — why am I still coughing?

The single most common leftover of COVID is nothing exotic — it is a lingering cough plus a lump of phlegm: twenty days later, your throat itches, you cough a little, and there is always a lump of white phlegm “hissing” in your throat, stuck there, uncomfortable. Doctor Luo says this question has come from so many friends that today he will explain it properly.

First, a rule: the TCM world says all kinds of things — pattern differentiation is the foundation

This pandemic has been fascinating inside the Chinese medicine world, with everyone explaining it differently: some say blood stasis, some say phlegm-stasis — phlegm blocking the capillaries where blood is congested; some say it is all cold-damp, others say warm-heat. The theories are endless.

💬 Note from Doctor Luo: I think you only need to grasp the main point. We in Chinese medicine still practice treatment based on pattern differentiation (bian zheng lun zhi). You cannot declare that this pandemic is simply cold-damp or simply warm-heat, and that everything else must be cold or must be heat — it really cannot be stated that way. You must go by the individual situation: everyone’s constitution differs, and when you caught the illness and how severely you caught it differ, so the reactions differ. Whenever someone speaks in absolutes, I would put a question mark next to it.

So how do we handle this leftover cough and lump of phlegm? Doctor Luo’s answer: first tell cold from heat — people split into two groups.

Type one: bright red tongue, no coating — yin-deficient lung dryness (heat)

Doctor Luo has seen many older people like this: tongue especially red — a tender red — with no coating on it (or only a very thin one), coughing and phlegmy too — the phlegm faintly tinged yellow, but not strongly yellow.

💬 Note from Doctor Luo: What is this? This is lung dryness (fei zao) — yin deficiency with heat. The body’s fluids are insufficient and there is deficiency heat, so the tongue body is red and has no coating; the throat is especially dry, and the phlegm you cough up can even carry a few streaks of blood.

What should such people do? Nourish yin and moisten dryness — replenish the fluids.

💬 Note from Doctor Luo: Use the approach of Qing Zao Jiu Fei Tang (Clear Dryness and Rescue the Lungs Decoction): put in e jiao (ass-hide gelatin), plus mai dong (dwarf lilyturf root) and sheng di (raw rehmannia) — all of these nourish yin and moisten dryness; add mulberry leaf (dong sang ye), three to six grams is enough; the original formula used ren shen (ginseng), and xi yang shen (American ginseng) works equally well. Huo ma ren (hemp seed) moistens the lungs and has a pulse-restoring (fu mai) action, so a little can be added; pi pa ye (loquat leaf) is cooling and clears lung heat; xing ren (apricot kernel) sends lung qi downward. With this approach, for people whose tongue is red, whose pulse races, and who have a dry cough that never quite clears, you simply moisten the dryness. Such people do exist among the leftovers of this pandemic, but they are not the majority.

If the throat is also itchy, add jin yin hua (honeysuckle) and lian qiao (forsythia), six grams each, to help clear things — the pathogen always has to be pushed outward bit by bit.

Type two (the majority): pale tongue, white coating — the cold pathogen has not left

What is more common? There is cold. Doctor Luo stresses it repeatedly: residual cough after an external contraction is mostly the cold pathogen at work — sometimes with a little heat mixed in, but cold is the main force.

💬 Note from Doctor Luo: In this kind of cough, the tongue body is pale, whitish, with a thin white coating on it; if the coating is a bit thick, you must first remove dampness — once the dampness is gone and the coating returns to normal, then apply the formula.

The cold pathogen has not left — how do we treat it? Two formulas: one heavy, one light.

The heavy weapon: Master Lin Hehe’s formula for chronic cough

For a cough that has gone on for a long time and truly will not stop, Doctor Luo has introduced Master Lin Hehe’s formula — a formula for long-standing cough with excellent results; for some reason few patients use it, and many cannot even gather all the ingredients.

💬 Note from Doctor Luo: Master Lin Hehe’s formula is a classic. I have used it for years, and for residual cough after external contraction the results really are good. Inside the formula there is the shadow of Xiao Qing Long Tang (Minor Green Dragon Decoction): wu wei zi (schisandra berry) and xi xin (asarum) form the foundation taken from Minor Green Dragon, plus gan jiang (dried ginger) — these scatter cold outward; then chen pi (aged tangerine peel), xing ren (apricot kernel) and ban xia (pinellia) dry dampness and transform phlegm — all warming. Why she gan (blackberry lily rhizome)? Because this kind of cough is throat-origin (yan yuan xing) — the pathogen is not down in the airways, it is not the rattling cough that comes from the trachea; the source sits in the throat, so she gan and mint clear and soothe the throat. Si gua luo (loofah sponge) transforms phlegm; a little sha shen (adenophora root) nourishes yin — you cannot use only warming herbs, you have to look after the other side too. Sometimes sang bai pi (mulberry root bark) and huang qin (scutellaria root) are added. This formula is a “big club” — a heavy weapon. When the cough really will not stop — nearly a month of coughing, miserable — this formula will basically stop it, driving the pathogen out.

Ordinary cases: Zhi Sou San — three to six grams, gently scattering cold outward

If it is not that severe, use Zhi Sou San (Stop Coughing Powder) — a very famous powder for scattering cold and stopping cough, made precisely for cold coughs.

💬 Note from Doctor Luo: Inside Zhi Sou San: jing jie (schizonepeta) — acrid, warm, releasing the exterior, able to scatter cold and resolve the surface; jie geng (platycodon root) — clears the throat and guides the medicinal qi upward; zi wan (aster root; some write it zi yuan) — warming, warms the lungs — sometimes kuan dong hua (coltsfoot flower) is substituted for zi wan, they can replace each other; then bai bu (stemona root), bai qian (cynanchum), chen pi, gan cao (licorice) — a very simple formula. This powder works outward; they are all warming herbs scattering cold, and the doses are small — three grams, six grams each is fine. For this kind of residual cough I generally add six grams of jin yin hua (honeysuckle) and six grams of lian qiao (forsythia) — why? To guard against lingering fire that has not fully cleared — there is still a little residual heat-pathogen inside. Add those two herbs and it generally works very well. For this kind of cold cough left after an external contraction, you usually do not even need Master Lin’s formula — three to five doses finish the job.

Do not want to drink herbs? Chen pi with su ye, brewed in water, is enough

If you really do not want to take Chinese medicine, there is a simple way.

💬 Note from Doctor Luo: Take some chen pi (aged tangerine peel) — one or two slices — plus a small pinch of su ye (perilla leaf), and brew them in water to drink. Just remember this: if your tongue is pale white, you have cold, so use warming things to scatter it; the phlegm dissolves too, and slowly the pathogen comes out. If it still feels itchy, add a little honeysuckle — a small amount of heat-clearing herb alongside — two forces working together, pushing the pathogen outward. And the thing to fear most is: using it backwards.

The worst mistake: drinking Chuan Bei Pi Pa Gao and autumn pear syrup for a cold pattern — cold on cold, leaving a root that lasts for years

What does “backwards” mean? Doctor Luo gives the two most common examples — as soon as many people start coughing, they run to the pharmacy for Chuan Bei Pi Pa Gao (fritillaria and loquat syrup) or autumn pear syrup.

💬 Note from Doctor Luo: I know an old physician who told me he had treated countless people like this: they caught cold, coughed, went to the pharmacy and bought Chuan Bei Pi Pa Gao or honey-steeped cough syrups of that kind. Chuan bei is cooling — you already have cold, and now cold is piled on cold, pressing the cold pathogen in; the body wants to fight back and cannot, and the result is a disease root left behind: every year at exactly this season you cough — when the time comes, you cough. That is what a leftover disease root looks like. And autumn pear syrup — it is sold out everywhere now; when you drink it, the throat feels comfortable, wonderfully smooth — but if your pattern is cold, you can drink it for days and it will not help, because it is also cold piled on cold.

And the reverse? The dry-heat pattern described earlier — bright red tongue, no coating, dry throat and mouth, maybe even blood streaks — chuan bei and pear syrup are perfectly fine for that: chuan bei is cooling, which is exactly what clears the heat, and the honey’s moistening is right too.

💬 Note from Doctor Luo: When you study Chinese medicine you must differentiate flexibly — no disease has only one pattern. At minimum, tell cold from heat: tongue pale white, body cool, even afraid of cold, thin coating, lots of saliva, yang qi insufficient, phlegm white — if you then take pear syrup and honeyed chuan bei, is that not backwards?

A lesson from medical school: hot coughs get cooling herbs, cold coughs get warming herbs

Doctor Luo brings this up every time he teaches — the mistake he made as a student.

💬 Note from Doctor Luo: When I first started studying Chinese medicine, I treated coughs by throwing every cough-stopping herb I knew at them — and it would not stop. Only later, after careful thought and study, did I understand: if the person is hot, the cough needs cooling herbs; if the person is cold, the cough needs warming herbs. If your patient’s cough is cold and I pile on chuan bei, zhe bei (Zhejiang fritillaria), pi pa ye — cooling things treating cold — do you think that can work? So this is something everyone must sort out: even for a single cough, you can at least roughly separate cold from heat.

Harmonizing cold and heat: the main force scatters cold, a small force clears heat

Cold and heat sometimes mix together; they are not always cleanly divided.

💬 Note from Doctor Luo: For example, inside a formula that scatters cold, I add a little jin yin hua (honeysuckle) and lian qiao (forsythia) — three or six grams — to clear whatever small amount of heat pathogen may still be inside, while cold remains the main issue. Scatter cold in quantity, add a little heat-clearing — this is harmonizing cold and heat. What is this? This is Chinese medicine’s practical, truth-seeking diagnostic thinking. We absolutely do not cling rigidly to a textbook — “the theory draws a line, so we follow that line” — that would be wrong. You have to stay flexible and adapt as things change.

Wrapping up: restore the spleen and stomach — when upright qi is full, everything is easier to adjust

Finally, Doctor Luo reminds everyone of one aftercare task — tonify the spleen and stomach.

💬 Note from Doctor Luo: Also replenish the spleen and stomach qi: drink water boiled with dried Chinese yam slices, or eat some yam paste, to fill out the spleen-stomach qi. As your upright qi grows fuller, scattering cold and clearing heat both become easier. Next I will walk through the dizziness and all the other problems you have been reporting — I hope that among all these lingering long-COVID symptoms, you will know what you are facing, know how to adjust, and get through smoothly, returning to a normal, healthy life. Tomorrow we continue with the residual symptoms after COVID. See you tomorrow!

What to take away

Tell cold from heat first. Lingering cough after COVID splits into two camps: the minority is heat — tender red tongue, little or no coating, dry throat, fast pulse, phlegm maybe streaked with blood; the majority is cold — pale tongue, thin white coating, maybe teeth marks, body cool. Mixing them up is the one mistake that leaves a cough returning every year at the same season.
Heat pattern (yin-deficient lung dryness): follow the Qing Zao Jiu Fei Tang approach — e jiao, mai dong, sheng di to nourish and moisten, mulberry leaf three to six grams, xi yang shen can stand in for ren shen, plus huo ma ren, pi pa ye, xing ren; add six grams each of honeysuckle and forsythia if the throat itches.
Cold pattern (the common one): if the coating is thick, clear the dampness first, then treat. For a stubborn near-month-long cough, use Master Lin Hehe’s formula built on Minor Green Dragon foundations (wu wei zi, xi xin, gan jiang to scatter cold; chen pi, xing ren, ban xia for damp-phlegm; she gan and mint for the throat-origin cough; si gua luo for phlegm; sha shen for yin). For ordinary cases, Zhi Sou San with tiny three-to-six-gram doses, usually plus six grams each of honeysuckle and forsythia to guard against lingering heat.
If you refuse herbs: one or two slices of chen pi and a pinch of su ye brewed in water — pale tongue means cold, warm herbs scatter it; add honeysuckle if it itches.
Never reverse the treatment: cold-pattern coughs must not take chuan bei (cooling) or pear syrup — cold on cold drives the pathogen in and leaves a yearly cough root; the dry-heat pattern with bright red tongue is exactly where they belong.
Finish with the spleen and stomach: yam-slice water or yam paste builds upright qi, and with qi full, both scattering cold and clearing heat succeed far more easily.

Compiled from Doctor Luo Dalun’s health lecture series (long-COVID series: telling cold from heat in the lingering cough).